Respiratory Emergency Considerations - Corrigan

Question 1

In emergency situations, what are the common respiratory presentations?

Answer 1

• Dyspnea
• Open Mouth Breathing
• Tachypnea
• Anorexia
• Vomiting/Gagging
• Exercise intolerance
• Cyanosis
• Fever
• ADR

Question 2

What are some important things to note about your patient when they present for respiratory emergency?

Answer 2

• Use of accessory muscles
• None to sucking chest wounds
• Frantic
• Discoloration of mucous membranes
• Laceration/Trauma
• Gasping/shallow breaths
• Anxiety
• Poor refill time
• Subcutaneous emphysema
• Etc.

Question 3

What important information does auscultation give you?

Answer 3

• Increased adventitial sounds (abnormal sounds heard in lungs and airways)
• Increased heart sounds
• Muffled heart sounds
• Referred upper airway noise
• Bronchial vs vesicular
  
  • Crackles (vesicular) and wheezes (bronchiole)

Question 4

When an animal presents in respiratory distress, what are your immediate concerns!!!!!

Answer 4

• DON’T STRESS THE ANIMAL
• OXYGEN
• Throacocentesis
• + sedative/anxiolytic

Question 5

What does oxygen delivery do in the blood?

Answer 5

Increases the partial pressure (PP) of O₂ in the blood and

decreases the partial pressure of other gases in the blood

Question 6

Methods of oxygen delivery?

Answer 6

• Flow by
• O₂ hood or plastic bag
• O₂ collar
• Nasal cath
• Trans tracheal
• O₂ cage

Question 7

How is giving O₂ to a patient w/ surgical wounds beneficial?

Answer 7

O₂decreases the rate of infection

Question 8

Is giving O₂to a P with pancreatitis helpful?

Answer 8

Yes

Question 9

When taking thoracic rads in emergency situations, remember not to take them if the animal is having trouble breathing.

If you can take them, what are some things you should look for?

Answer 9

• Elevation of cardiac silhoutte
• Atelectatic lung lobes
• Attenuation of vascular pattern →vascular should extend close to chest wall normally →in this case lungs are not extending to chest wall anymore
• Rounded lung margins → Chronic effusions/hemo/pyo

Question 10

Corrigan says don’t be scared of throracocentesis…..Throracocentesis is __________________________________

Answer 10

Therapeutic, Diagnostic, and Prognostic

Question 11

Where should you insert your needle for a thoracocentesis?

Answer 11

Between the 7^th and 9^th ICS

Go off the front side/cranial edge of the ribs

Bevel angled flat to the lungs

Question 12

What are the main 2 categories of pneumothorax?

Which type is more common?

Answer 12

• Open
• Closed (more common)

Question 13

What are some problems associated with a Pneumothorax?

Answer 13

• Decrease in compliance
• Atelectasis
• V/Q mismatch
• Arterial hypoxia
• Myocardial dysfxn
• Lactic acidosis
• Hypercarbic acidosis

Question 14

What type of pneumothorax are we concerned about in animals that have been HBC?

Why?

Answer 14

• Tension pneumothorax
  
  • due to chest compressed w/ a closed glottis (gasping for air)

Question 15

Describe what happens during a Tension pneumothorax.

Answer 15

• One-way “valve” is created when a Bleb ruptured.
  
  • Inspiration → sucks air into the lungs
  • Expiration → closes the valve
• Increased intrathroacic pressure
• Decreased venous return → SHOCK

Question 16

Which kind of dogs are prone to Spontaneous Pneumothorax?

Answer 16

• Ones w/ evidence of pulmonary dz.
• Deep chested large breed dogs
• Huskies

Question 17

List the 5 different Cavitary Lung Lesions?

Answer 17

• Blebs
• Bullae
• Pneumatoceles
• Cysts
• Abscesses/granulomas

Question 18

What cavitary lesion is the result of destruction, dilation & convergence of contiguous alveoli?

What is it secondary to?

Which lung lobe is more often involved?

Answer 18

• Bullae
• Obstruction of small airways
• Right, middle lung lobe

Question 19

List things that can cause a Spontaneous Pneumothorax.

Answer 19

• Cavitary lesions
• FBs
• Pneumonia
• HWs
• Chronic granulomatous infections
• Neoplasia
• Asthma

Question 20

How can you routinely cause Iatrogenic Pneumothorax?

Answer 20

• Intubation → especially in cats
• Overinflation of cuffs
• Moving w/o disconnecting tubing
• Extubation w/o decuffing

Question 21

You do a thoracocentesis & pull off fluid that looks like this.

What’s your DX?

Answer 21

Neoplasia :(

Question 22

When is it time to place a Chest Tube?

Answer 22

• If you can’t attain negative pressure w/ thoracocentesis.
• If you pull of > 10 mL/Kg in 12 hrs.
• If you have to tap more that 3 times

Question 23

How is a Chest Tube placed?

Answer 23

1. Select a tube the size of mainstem bronchus
2. GA &/o local block
3. 10^th - 11^th ICS
4. Tunnel perpendicularlly under the skin 3 to 4 ICS’s cranially
5. Brisk thrust parallel to the chest

Question 24

Where do you want your Chest Tube to sit?
How are you going to confirm this?

Is it going to stay there?

Answer 24

• Cranioventral pleural space to the level of the 2^nd rib
• Rads
• Maybe?????? If you are lucky!

Question 25

Compression on the Lungs causes all sorts of problems.

Can you list some?

Answer 25

• Decrease in compliance
• Atelectasis
• V/Q mismatch
• Arterial hypoxia
• Myocardial dysfxn
• Lactic acidosis
• Hypercarbic acidosis
• Hypoxic pulmonary vasoconstriction
• Pulmonary hypertension
• R heart compromise & failure

Question 26

What are some monitoring parameters that let you know you have a Respiratory Emergency?

Answer 26

• ECG S-T segment changes
• BP: 80/150
• Low pulse pressures
• Weak doppler flow
• Rectal vs. extremitiy temp difference > 10°
• Temp > 104°F
• Pulse ox < 92%
• < 3 Central Venous Pressure
• Low urine output

Question 27

TX options for a Traumatic Pneumothorax?

Answer 27

Usually can just tap

Question 28

TX options for Spontaneous Pneumothorax?

Recurrence rate?

Answer 28

• SX
• Recurrence w/ SX is 0-25% as compared to 50-100% w/ taps/tubes

Question 29

How do you know when it’s okay to pull your patient’s chest tube?

Answer 29

when you get 2-4 mL/Kg/d of fluid

(coming from the tube now & not the chest)